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Li X, Liu Y, Li M, Bian J, Song D, Liu C. Epidemiological investigation of lower respiratory tract infections during influenza A (H1N1) pdm09 virus pandemic based on targeted next-generation sequencing. Front Cell Infect Microbiol 2023; 13:1303456. [PMID: 38162581 PMCID: PMC10755937 DOI: 10.3389/fcimb.2023.1303456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
Background Co-infection has been a significant contributor to morbidity and mortality in previous influenza pandemics. However, the current influenza A (H1N1) pdm09 virus pandemic, as the first major outbreak following the SARS-CoV-2 pandemic, may differ epidemiologically. Further investigation is necessary to understand the specific features and impact of this influenza A pandemic. Study design: We conducted a retrospective cohort study at a Chinese hospital between January and April 2023, focusing on patients with lower respiratory tract infections. Pathogen detection employed targeted next-generation sequencing (tNGS) on bronchoalveolar lavage fluid (BALF) or sputum samples. Results This study enrolled 167 patients with lower respiratory tract infections, and the overall positivity rate detected through tNGS was around 80%. Among them, 40 patients had influenza A (H1N1) pdm09 virus infection, peaking in March. In these patients, 27.5% had sole infections, and 72.5% had co-infections, commonly with bacteria. The frequently detected pathogens were Aspergillus fumigatus, SARS-CoV-2, and Streptococcus pneumoniae. For non-influenza A virus-infected patients, the co-infection rate was 36.1%, with 42.3% having SARS-CoV-2. Patients with influenza A virus infection were younger, had more females and diabetes cases. Among them, those with sole infections were older, with less fever and asthma but more smoking history. Regarding prognosis, compared to sole influenza A virus infection, co-infected patients demonstrated higher 21-day recovery rates and a higher incidence of heart failure. However, they exhibited lower proportions of respiratory failure, acute kidney failure, septic shock, and hospital stays lasting more than 10 days. Interestingly, patients with non-influenza A virus infection had a significantly lower 21-day recovery rate. Correlation analysis indicated that the 21-day recovery rate was only associated with influenza A (H1N1) pdm09 virus. Conclusion During the current pandemic, the influenza A (H1N1) pdm09 virus may have been influenced by the SARS-CoV-2 pandemic and did not exhibit a strong pathogenicity. In fact, patients infected with influenza A virus showed better prognoses compared to those infected with other pathogens. Additionally, tNGS demonstrated excellent detection performance in this study and showed great potential, prompting clinical physicians to consider its use as an auxiliary diagnostic tool.
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Affiliation(s)
- Xiaodan Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Yang Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Minzhe Li
- Department of Respiratory and Critical Care Medicine, The First Hospital of Jilin University-the Eastern Division, Changchun, China
| | - Jing Bian
- Department of Respiratory Medicine, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Demei Song
- Department of Respiratory Medicine, The First Affiliated Hospital of Jilin University, Changchun, China
| | - Chaoying Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Jilin University, Changchun, China
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Grant RA, Poor TA, Sichizya L, Diaz E, Bailey JI, Soni S, Senkow KJ, Pérez-Leonor XG, Abdala-Valencia H, Lu Z, Donnelly HK, Tighe RM, Lomasney JW, Wunderink RG, Singer BD, Misharin AV, Budinger GS. Prolonged exposure to lung-derived cytokines is associated with inflammatory activation of microglia in patients with COVID-19. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.28.550765. [PMID: 37546860 PMCID: PMC10402123 DOI: 10.1101/2023.07.28.550765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Neurological impairment is the most common finding in patients with post-acute sequelae of COVID-19. Furthermore, survivors of pneumonia from any cause have an elevated risk of dementia1-4. Dysfunction in microglia, the primary immune cell in the brain, has been linked to cognitive impairment in murine models of dementia and in humans5. Here, we report a transcriptional response in human microglia collected from patients who died following COVID-19 suggestive of their activation by TNF-α and other circulating pro-inflammatory cytokines. Consistent with these findings, the levels of 55 alveolar and plasma cytokines were elevated in a cohort of 341 patients with respiratory failure, including 93 unvaccinated patients with COVID-19 and 203 patients with other causes of pneumonia. While peak levels of pro-inflammatory cytokines were similar in patients with pneumonia irrespective of etiology, cumulative cytokine exposure was higher in patients with COVID-19. Corticosteroid treatment, which has been shown to be beneficial in patients with COVID-196, was associated with lower levels of CXCL10, CCL8, and CCL2-molecules that sustain inflammatory circuits between alveolar macrophages harboring SARS-CoV-2 and activated T cells7. These findings suggest that corticosteroids may break this cycle and decrease systemic exposure to lung-derived cytokines and inflammatory activation of microglia in patients with COVID-19.
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Affiliation(s)
- Rogan A Grant
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Taylor A Poor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lango Sichizya
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Estefani Diaz
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joseph I Bailey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sahil Soni
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karolina J Senkow
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Xochítl G Pérez-Leonor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hiam Abdala-Valencia
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ziyan Lu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Helen K Donnelly
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert M Tighe
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Jon W Lomasney
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Benjamin D Singer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Biochemistry and Molecular Genetics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alexander V Misharin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gr Scott Budinger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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3
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Smiechowicz J, Barteczko-Grajek B, Adamik B, Bojko J, Gozdzik W, Lipinska-Gediga M. Influenza in patients with respiratory failure admitted to intensive care units in Poland and the use of extracorporeal respiratory support: a survey-based multicenter study. BMC Infect Dis 2021; 21:954. [PMID: 34525950 PMCID: PMC8441232 DOI: 10.1186/s12879-021-06672-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background In Poland, little is known about the most serious cases of influenza that need admittance to the intensive care unit (ICU), as well as the use of extracorporeal respiratory support. Methods This was an electronic survey comprising ICUs in two administrative regions of Poland. The aim of the study was to determine the number of influenza patients with respiratory failure admitted to the ICU in the autumn–winter season of 2018/2019. Furthermore, respiratory support, outcome and other pathogens detected in the airways were investigated. Results Influenza infection was confirmed in 76 patients. The A(H1N1)pdm09 strain was the most common. 34 patients died (44.7%). The median age was 62 years, the median sequential organ failure assessment (SOFA) score was 11 and was higher in patients who died (12 vs. 10, p = 0.017). Mechanical ventilation was used in 75 patients and high flow nasal oxygen therapy in 1 patient. Extracorporeal membrane oxygenation (ECMO) was used in 7 patients (6 survived), and extracorporeal carbon dioxide removal (ECCO2R) in 2 (1 survived). The prone position was used in 16 patients. In addition, other pathogens were detected in the airways on admittance to the ICU. Conclusion A substantial number of influenza infections occurred in the autumn–winter season of 2018/2019 that required costly treatment in the intensive care units. Upon admission to the ICU, influenza patients had a high degree of organ failure as assessed by the SOFA score, and the mortality rate was 44.7%. Advanced extracorporeal respiratory techniques offer real survival opportunities to patients with severe influenza-related ARDS. The presence of coinfection should be considered in patients with influenza and respiratory failure. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06672-w.
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Affiliation(s)
- Jakub Smiechowicz
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland.
| | - Barbara Barteczko-Grajek
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Barbara Adamik
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Jozef Bojko
- Department of Anaesthesiology and Intensive Therapy, Provincial Hospital in Opole, Kosnego 53, 46-020, Opole, Poland
| | - Waldemar Gozdzik
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Malgorzata Lipinska-Gediga
- Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland.,Department of Anaesthesiology and Intensive Therapy, 4th Military Hospital of Wroclaw, Weigla 5, 50-981, Wrocław, Poland
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4
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Budinger GS, Misharin AV, Ridge KM, Singer BD, Wunderink RG. Distinctive features of severe SARS-CoV-2 pneumonia. J Clin Invest 2021; 131:149412. [PMID: 34263736 PMCID: PMC8279580 DOI: 10.1172/jci149412] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is among the most important public health crises of our generation. Despite the promise of prevention offered by effective vaccines, patients with severe COVID-19 will continue to populate hospitals and intensive care units for the foreseeable future. The most common clinical presentation of severe COVID-19 is hypoxemia and respiratory failure, typical of the acute respiratory distress syndrome (ARDS). Whether the clinical features and pathobiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia differ from those of pneumonia secondary to other pathogens is unclear. This uncertainty has created variability in the application of historically proven therapies for ARDS to patients with COVID-19. We review the available literature and find many similarities between patients with ARDS from pneumonia attributable to SARS-CoV-2 versus other respiratory pathogens. A notable exception is the long duration of illness among patients with COVID-19, which could result from its unique pathobiology. Available data support the use of care pathways and therapies proven effective for patients with ARDS, while pointing to unique features that might be therapeutically targeted for patients with severe SARS-CoV-2 pneumonia.
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Liu Y, Ling L, Wong SH, Wang MHT, Fitzgerald J, Zou X, Fang S, Liu X, Wang X, Hu W, Chan H, Wang Y, Huang D, Li Q, Wong WT, Choi G, Zou H, Hui DSC, Yu J, Tse G, Gin T, Wu WKK, Chan MTV, Zhang L. Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients. EClinicalMedicine 2021; 37:100955. [PMID: 34386745 PMCID: PMC8343259 DOI: 10.1016/j.eclinm.2021.100955] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Viral infections of the respiratory tract represent a major global health concern. Co-infection with bacteria may contribute to severe disease and increased mortality in patients. Nevertheless, viral-bacterial co-infection patterns and their clinical outcomes have not been well characterized to date. This study aimed to evaluate the clinical features and outcomes of patients with viral-bacterial respiratory tract co-infections. METHODS We included 19,361 patients with respiratory infection due to respiratory viruses [influenza A and B, respiratory syncytial virus (RSV), parainfluenza] and/or bacteria in four tertiary hospitals in Hong Kong from 2013 to 2017 using a large territory-wide healthcare database. All microbiological tests were conducted within 48 h of hospital admission. Four etiological groups were included: (1) viral infection alone; (2) bacterial infection alone; (3) laboratory-confirmed viral-bacterial co-infection and (4) clinically suspected viral-bacterial co-infection who were tested positive for respiratory virus and negative for bacteria but had received at least four days of antibiotics. Clinical features and outcomes were recorded for laboratory-confirmed viral-bacterial co-infection patients compared to other three groups as control. The primary outcome was 30-day mortality. Secondary outcomes were intensive care unit (ICU) admission and length of hospital stay. Propensity score matching estimated by binary logistic regression was used to adjust for the potential bias that may affect the association between outcomes and covariates. FINDINGS Among 15,906 patients with respiratory viral infection, there were 8451 (53.1%) clinically suspected and 1,087 (6.8%) laboratory-confirmed viral-bacterial co-infection. Among all the bacterial species, Haemophilus influenzae (226/1,087, 20.8%), Pseudomonas aeruginosa (180/1087, 16.6%) and Streptococcus pneumoniae (123/1087, 11.3%) were the three most common bacterial pathogens in the laboratory-confirmed co-infection group. Respiratory viruses co-infected with non-pneumococcal streptococci or methicillin-resistant Staphylococcus aureus was associated with the highest death rate [9/30 (30%) and 13/48 (27.1%), respectively] in this cohort. Compared with other infection groups, patients with laboratory-confirmed co-infection had higher ICU admission rate (p < 0.001) and mortality rate at 30 days (p = 0.028), and these results persisted after adjustment for potential confounders using propensity score matching. Furthermore, patients with laboratory-confirmed co-infection had significantly higher mortality compared to patients with bacterial infection alone. INTERPRETATION In our cohort, bacterial co-infection is common in hospitalized patients with viral respiratory tract infection and is associated with higher ICU admission rate and mortality. Therefore, active surveillance for bacterial co-infection and early antibiotic treatment may be required to improve outcomes in patients with respiratory viral infection.
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Affiliation(s)
- Yingzhi Liu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Lowell Ling
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Maggie HT Wang
- School of Public Health, The Chinese University of Hong Kong, Hong Kong, PR China
| | | | - Xuan Zou
- Shenzhen Center for Disease Control and Prevention, No.8, Longyuan Road, Nanshan District, Shenzhen, Guangdong Province, PR China
| | - Shisong Fang
- Shenzhen Center for Disease Control and Prevention, No.8, Longyuan Road, Nanshan District, Shenzhen, Guangdong Province, PR China
| | - Xiaodong Liu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Xiansong Wang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Wei Hu
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Hung Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Yan Wang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Dan Huang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Qing Li
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Wai T Wong
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Gordon Choi
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - David SC Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Jun Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - Tony Gin
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - William KK Wu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
| | - Matthew TV Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
| | - Lin Zhang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
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Gu R, Mao T, Lu Q, Tianjiao Su T, Wang J. Myeloid dysregulation and therapeutic intervention in COVID-19. Semin Immunol 2021; 55:101524. [PMID: 34823995 PMCID: PMC8576142 DOI: 10.1016/j.smim.2021.101524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022]
Abstract
The dysregulation of myeloid cell responses is increasingly demonstrated to be a major mechanism of pathogenesis for COVID-19. The pathological cellular and cytokine signatures associated with this disease point to a critical role of a hyperactivated innate immune response in driving pathology. Unique immunopathological features of COVID-19 include myeloid-cell dominant inflammation and cytokine release syndrome (CRS) alongside lymphopenia and acute respiratory distress syndrome (ARDS), all of which correlate with severe disease. Studies suggest a range of causes mediating myeloid hyperactivation, such as aberrant innate sensing, asynchronized immune cellular responses, as well as direct viral protein/host interactions. These include the recent identification of new myeloid cell receptors that bind SARS-CoV-2, which drive myeloid cell hyperinflammatory responses independently of lung epithelial cell infection via the canonical receptor, angiotensin-converting enzyme 2 (ACE2). The spectrum and nature of myeloid cell dysregulation in COVID-19 also differs from, at least to some extent, what is observed in other infectious diseases involving myeloid cell activation. While much of the therapeutic effort has focused on preventative measures with vaccines or neutralizing antibodies that block viral infection, recent clinical trials have also targeted myeloid cells and the associated cytokines as a means to resolve CRS and severe disease, with promising but thus far modest effects. In this review, we critically examine potential mechanisms driving myeloid cell dysregulation, leading to immunopathology and severe disease, and discuss potential therapeutic strategies targeting myeloid cells as a new paradigm for COVID-19 treatment.
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Affiliation(s)
- Runxia Gu
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Tianyang Mao
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Qiao Lu
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, 10016, USA; The Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, 10016, USA
| | - Tina Tianjiao Su
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, 06520, USA.
| | - Jun Wang
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, 10016, USA; The Laura and Isaac Perlmutter Cancer Center, New York University Langone Health, New York, NY, 10016, USA.
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7
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Bain R, Cosgriff R, Zampoli M, Elbert A, Burgel PR, Carr SB, Castaños C, Colombo C, Corvol H, Faro A, Goss CH, Gutierrez H, Jung A, Kashirskaya N, Marshall BC, Melo J, Mondejar-Lopez P, de Monestrol I, Naehrlich L, Padoan R, Pastor-Vivero MD, Rizvi S, Salvatore M, Filho LVRFDS, Brownlee KG, Haq IJ, Brodlie M. Clinical characteristics of SARS-CoV-2 infection in children with cystic fibrosis: An international observational study. J Cyst Fibros 2021; 20:25-30. [PMID: 33309057 PMCID: PMC7713571 DOI: 10.1016/j.jcf.2020.11.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND The presence of co-morbidities, including underlying respiratory problems, has been identified as a risk factor for severe COVID-19 disease. Information on the clinical course of SARS-CoV-2 infection in children with cystic fibrosis (CF) is limited, yet vital to provide accurate advice for children with CF, their families, caregivers and clinical teams. METHODS Cases of SARS-CoV-2 infection in children with CF aged less than 18 years were collated by the CF Registry Global Harmonization Group across 13 countries between 1 February and 7 August 2020. RESULTS Data on 105 children were collated and analysed. Median age of cases was ten years (interquartile range 6-15), 54% were male and median percentage predicted forced expiratory volume in one second was 94% (interquartile range 79-104). The majority (71%) of children were managed in the community during their COVID-19 illness. Out of 24 children admitted to hospital, six required supplementary oxygen and two non-invasive ventilation. Around half were prescribed antibiotics, five children received antiviral treatments, four azithromycin and one additional corticosteroids. Children that were hospitalised had lower lung function and reduced body mass index Z-scores. One child died six weeks after testing positive for SARS-CoV-2 following a deterioration that was not attributed to COVID-19 disease. CONCLUSIONS SARS-CoV-2 infection in children with CF is usually associated with a mild illness in those who do not have pre-existing severe lung disease.
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Affiliation(s)
- Robert Bain
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Marco Zampoli
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | | | - Pierre-Régis Burgel
- Respiratory Medicine and National Reference CF Center, AP-HP Hôpital Cochin, Paris, France; Université de Paris, Institut Cochin, Inserm U-1016, Paris, France
| | - Siobhán B Carr
- Royal Brompton Hospital and Imperial College London, United Kingdom
| | - Claudio Castaños
- Department of Pulmonology, Hospital de Pediatria JP Garrahan, Buenos Aires, Argentina
| | - Carla Colombo
- CF Regional Reference Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Harriet Corvol
- Sorbonne Université, Inserm, Centre de Recherche Saint-Antoine, Assistance Publique Hôpitaux de Paris (APHP), Hôpital Trousseau, Service de Pneumologie Pédiatrique, Paris, France
| | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Christopher H Goss
- Department of Medicine and Pediatrics, University of Washington, Seattle, WA, United States
| | - Hector Gutierrez
- Pediatric Pulmonary and Sleep Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Andreas Jung
- Department of Pulmonology and Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nataliya Kashirskaya
- Laboratory of Genetic Epidemiology, Research Centre for Medical Genetics, Moscow, Russian Federation
| | | | - Joel Melo
- Instituo Nacional del Tórax, Santiago, Chile
| | - Pedro Mondejar-Lopez
- Pediatric Pulmonology and Cystic Fibrosis Unit, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Isabelle de Monestrol
- Stockholm Cystic Fibrosis Centre Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Lutz Naehrlich
- Universities of Giessen and Marburg Lung Center, German Center of Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
| | - Rita Padoan
- Cystic Fibrosis Support Center, Department of Paediatric, University of Brescia, Italy
| | - Maria Dolores Pastor-Vivero
- Pediatric Pulmonology and Cystic Fibrosis Unit, Osakidetza, Hospital Universitario Cruces, Barakado, Bizkaia, Spain
| | - Samar Rizvi
- Cystic Fibrosis Foundation, Bethesda, MD, United States
| | - Marco Salvatore
- National Center Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Iram J Haq
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
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Lee DU, Fan GH, Hastie DJ, Prakasam VN, Addonizio EA, Ahern RR, Seog KJ, Karagozian R. The Clinical Impact of Cirrhosis on the Hospital Outcomes of Patients Admitted With Influenza Infection: Propensity Score Matched Analysis of 2011-2017 US Hospital Data. J Clin Exp Hepatol 2021; 11:531-543. [PMID: 34511813 PMCID: PMC8414330 DOI: 10.1016/j.jceh.2021.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES Patients with cirrhosis have liver-related immune dysfunction that potentially predisposes the patients to increased influenza infection risk. Our study evaluates this cross-sectional relationship using a national registry of hospital patients. METHODS This study included the 2011-2017 National Inpatient Sample database. From this, respiratory influenza cases were isolated and stratified using the presence of cirrhosis into a cirrhosis-present study cohort and cirrhosis-absent controls; propensity score matching method was used to match the controls to the study cohort (cirrhosis-present) using a 1:1 matching ratio. The endpoints included mortality, length of stay, hospitalization costs, and influenza-related complications. RESULTS Following the match, there were 2,040 with cirrhosis and matched 2,040 without cirrhosis admitted with respiratory influenza infection. Compared to the controls, cirrhosis patients had higher in-hospital mortality (7.79 vs 3.43% p < 0.001, OR 2.38 95% CI 1.78-3.17), longer length of stay (7.25 vs 6.52 d p < 0.001), higher hospitalization costs ($70,009 vs $65,035 p < 0.001), and were more likely be discharged to a skilled nursing facility and home healthcare (vs routine home discharges). In terms of influenza-related complications, the cirrhosis cohort had higher rates of sepsis (29.8 vs 22% p < 0.001, OR 1.51 95% CI 1.31-1.74). In the multivariate regression analysis, cirrhosis was associated with higher mortality (p < 0.001, aOR 2.31 95% CI 1.59-3.35) and length of stay (p = 0.018, aOR 1.03 95% CI 1.01-1.06). In subgroup analysis of patients with decompensated (n = 597) versus compensated cirrhosis (n = 1443), those with decompensated cirrhosis had higher rates of in-hospital mortality (12.7 vs 5.75% p < 0.001, OR 2.39 95% CI 1.72-3.32), length of stay (8.85 vs 6.59 d p < 0.001), and hospitalization costs ($92,858 vs $60,556 p < 0.001). In the multivariate analysis, decompensated cirrhosis was associated with increased mortality (p < 0.001, aOR 2.86 95% CI 1.90-4.32). CONCLUSION This study shows the presence of cirrhosis to result in higher hospital mortality and postinfluenza complications in patients with influenza infection.
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Key Words
- AHRQ, agency for healthcare research and quality
- DRG, diagnosis-related group
- HCUP, healthcare cost and utilization project
- ICD-10, international classification of diseases, tenth edition
- ICD-9, international classification of diseases, ninth edition
- NIS, nationwide inpatient sample
- SBP, spontaneous bacterial peritonitis
- SID, state inpatient database
- VIF, variation inflation factor
- ascites
- common cold
- flu
- influenza-related complications
- portal hypertension
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Affiliation(s)
- David U. Lee
- Address for correspondence: David Uihwan Lee MD, Liver Center, Division of Gastroenterology, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA. T: 617-636-4168, F: 617-636-9292.
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9
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Crimi C, Noto A, Cortegiani A, Impellizzeri P, Elliott M, Ambrosino N, Gregoretti C. Noninvasive respiratory support in acute hypoxemic respiratory failure associated with COVID-19 and other viral infections. Minerva Anestesiol 2020; 86:1190-1204. [DOI: 10.23736/s0375-9393.20.14785-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Suttapanit K, Boriboon J, Sanguanwit P. Risk factors for non-invasive ventilation failure in influenza infection with acute respiratory failure in emergency department. Am J Emerg Med 2020; 45:368-373. [PMID: 33041144 DOI: 10.1016/j.ajem.2020.08.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Non-invasive ventilation (NIV) has been widely used in hypoxemic acute respiratory failure (ARF) due to influenza pneumonia in the emergency department (ED). However, NIV used in influenza-associated acute respiratory failure had a variable rate of failure. Previous studies have reported that prolonged use of NIV was associated with increased mortality. Our study aimed to identify risk factors for NIV failure in influenza infection with acute respiratory failure in ED. METHOD We performed a retrospective cohort observational study. Enrolled patients were older than 18 years who used NIV due to influenza infection with ARF between 1 January 2017 to 31 December 2018 in Ramathibodi Emergency Department. Patients characteristics, comorbidity, clinical, laboratory outcome, chest imaging, initial NIV setting, and parameters were collected in ED setting. Sequential organ failure assessment (SOFA) score and PaO2/FiO2 (PF) ratio were calculated from the first arterial blood gas in ED. We followed the outcome success or failure of the NIV used. RESULTS A total of 162 patients were enrolled and 72 (44%) suffered NIV failure in influenza infection with ARF. We used univariate and multivariate logistic analyses to assess risk factors for NIV failure. The ability of risk factor to predict NIV failure was analyzed using the area under the receiver operating characteristic (AUROC). Risk factors of NIV failure included SOFA score (P = 0.001), PF ratio (P = 0.001) and quadrant infiltrations in chest x-rays (CXR) (P = 0.001). SOFA score, PF ratio, and number quadrant infiltrations in chest radiography have good ability to predict NIV failure, AUROC 0.894 (95%CI 0.839-0.948), 0.828 (95%CI 0.764-0.892), and 0.792 (95%CI 0.721-0.863), respectively and no significant difference in the ability to predict NIV failure among three parameters. The use of PF ratio plus number quadrant infiltrations in chest radiography demonstrated a higher predictive ability for NIV failure in influenza infection with ARF. CONCLUSIONS SOFA score, PF ratio, and quadrant infiltrations in chest radiography were good predictors of NIV failure in influenza infection with ARF.
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Affiliation(s)
- Karn Suttapanit
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Jeeranun Boriboon
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Pitsucha Sanguanwit
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand.
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Cinesi Gómez C, Peñuelas Rodríguez Ó, Luján Torné M, Egea Santaolalla C, Masa Jiménez JF, García Fernández J, Carratalá Perales JM, Heili-Frades SB, Ferrer Monreal M, de Andrés Nilsson JM, Lista Arias E, Sánchez Rocamora JL, Garrote JI, Zamorano Serrano MJ, González Martínez M, Farrero Muñoz E, Mediano San Andrés O, Rialp Cervera G, Mas Serra A, Hernández Martínez G, de Haro López C, Roca Gas O, Ferrer Roca R, Romero Berrocal A, Ferrando Ortola C. Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection. MEDICINA INTENSIVA (ENGLISH EDITION) 2020. [PMCID: PMC7304399 DOI: 10.1016/j.medine.2020.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.
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12
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Cinesi Gómez C, Peñuelas Rodríguez Ó, Luján Torné ML, Egea Santaolalla C, Masa Jiménez JF, García Fernández J, Carratalá Perales JM, Heili-Frades SB, Ferrer Monreal M, de Andrés Nilsson JM, Lista Arias E, Sánchez Rocamora JL, Garrote JI, Zamorano Serrano MJ, González Martínez M, Farrero Muñoz E, Mediano San Andrés O, Rialp Cervera G, Mas Serra A, Hernández Martínez G, de Haro López C, Roca Gas O, Ferrer Roca R, Romero Berrocal A, Ferrando Ortola C. Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 67:261-270. [PMID: 32307151 PMCID: PMC7161530 DOI: 10.1016/j.redar.2020.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.
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Affiliation(s)
- C Cinesi Gómez
- Dirección General de Asistencia Sanitaria, Servicio Murciano de Salud. Director del Máster Oficial en Medicina de Urgencias y Emergencias, Murcia, España
| | - Ó Peñuelas Rodríguez
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe. CIBER de Enfermedades Respiratorias, CIBERES, Getafe, Madrid, España
| | - M L Luján Torné
- Servicio de Neumología, Hospital de Sabadell, Corporació Parc Taulí, Universitat Autònoma de Barcelona. Centro de Investigación Biomédica en Red (CIBERES), Sabadell, Barcelona, España.
| | - C Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario ARaba. OSI araba, Vitoria-Gasteiz, España
| | - J F Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara. CIBER de Enfermedades Respiratorias (CIBERES). Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, España
| | - J García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro, Madrid, España
| | - J M Carratalá Perales
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España
| | - S B Heili-Frades
- Jefe Asociado de Neumología, responsable de la UCIR, Hospital Universitario Fundación Jiménez Díaz. CIBERES, REVA, EMDOS, Madrid, España
| | - M Ferrer Monreal
- Servei de Pneumologia, Institut Clínic de Respiratori, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, España
| | | | - E Lista Arias
- Servicio de Urgencias, Parc Taulí Hospital Universitari, Sabadell, Barcelona, España
| | - J L Sánchez Rocamora
- Servicio de Urgencias, Hospital General de Villarrobledo, Villarrobledo, Albacete, España
| | - J I Garrote
- Médico de Emergencias GUETS, SESCAM. Coordinador docente Eliance, España
| | | | - M González Martínez
- Unidad de Sueño y Ventilación, Neumología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España
| | - E Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - O Mediano San Andrés
- Unidad del Sueño, Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
| | - G Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, España
| | - A Mas Serra
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Hospital General d'Hospitalet, Sant Joan Despí, Barcelona, España
| | - G Hernández Martínez
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de la Salud, Toledo, España
| | - C de Haro López
- Área de Críticos, Corporació Sanitària i Universitària Parc Taulí. CIBER Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Sabadell, Barcelona, España
| | - O Roca Gas
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona. Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Barcelona, España
| | - R Ferrer Roca
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Institut de Recerca. CIBER de Enfermedades Respiratorias, CIBERES, Barcelona, España
| | - A Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Madrid, España
| | - C Ferrando Ortola
- Jefe de Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, España
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Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN (ENGLISH EDITION) 2020. [PMCID: PMC7203031 DOI: 10.1016/j.redare.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.
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14
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Cinesi Gómez C, Peñuelas Rodríguez Ó, Luján Torné M, Egea Santaolalla C, Masa Jiménez JF, García Fernández J, Carratalá Perales JM, Heili-Frades SB, Ferrer Monreal M, de Andrés Nilsson JM, Lista Arias E, Sánchez Rocamora JL, Garrote JI, Zamorano Serrano MJ, González Martínez M, Farrero Muñoz E, Mediano San Andrés O, Rialp Cervera G, Mas Serra A, Hernández Martínez G, de Haro López C, Roca Gas O, Ferrer Roca R, Romero Berrocal A, Ferrando Ortola C. [Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection]. Med Intensiva 2020; 44:429-438. [PMID: 32312600 PMCID: PMC7270576 DOI: 10.1016/j.medin.2020.03.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 01/08/2023]
Abstract
La enfermedad por coronavirus 2019 (COVID-19) es una infección del tracto respiratorio causada por un nuevo coronavirus emergente que se reconoció por primera vez en Wuhan, China, en diciembre de 2019. Actualmente la Organización Mundial de la Salud (OMS) ha definido la infección como pandemia y existe una situación de emergencia sanitaria y social para el manejo de esta nueva infección. Mientras que la mayoría de las personas con COVID-19 desarrollan solo una enfermedad leve o no complicada, aproximadamente el 14% desarrollan una enfermedad grave que requiere hospitalización y oxígeno, y el 5% pueden requerir ingreso en una unidad de cuidados intensivos. En casos severos, COVID-19 puede complicarse por el síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico y fracaso multiorgánico. Este documento de consenso se ha preparado sobre directrices basadas en evidencia desarrolladas por un panel multidisciplinario de profesionales médicos de cuatro sociedades científicas españolas (Sociedad Española de Medicina Intensiva y Unidades Coronarias [SEMICYUC], Sociedad Española de Neumología y Cirugía Torácica [SEPAR], Sociedad Española de Urgencias y Emergencias [SEMES], Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor [SEDAR]) con experiencia en el manejo clínico de pacientes con COVID-19 y otras infecciones virales, incluido el SARS, así como en sepsis y SDRA. El documento proporciona recomendaciones clínicas para el soporte respiratorio no invasivo (ventilación no invasiva, oxigenoterapia de alto flujo con cánula nasal) en cualquier paciente con presentación sospechada o confirmada de COVID-19 con insuficiencia respiratoria aguda. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos.
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Affiliation(s)
- César Cinesi Gómez
- Dirección General de Asistencia Sanitaria, Servicio Murciano de Salud. Director del Máster Oficial en Medicina de Urgencias y Emergencias, Murcia, España
| | - Óscar Peñuelas Rodríguez
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe. CIBER de Enfermedades Respiratorias, CIBERES, Getafe, Madrid, España.
| | - Manel Luján Torné
- Servicio de Neumología, Hospital de Sabadell, Corporació Parc Taulí, Universitat Autònoma de Barcelona. Centro de Investigación Biomédica en Red, CIBERES, Sabadell, Barcelona, España
| | | | - Juan Fernando Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara. CIBER de Enfermedades Respiratorias (CIBERES). Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, España
| | - Javier García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro, Madrid, España
| | - José Manuel Carratalá Perales
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España
| | - Sarah Béatrice Heili-Frades
- Unidad de Neumología, Responsable de la UCIR, Hospital Universitario Fundación Jiménez Díaz. CIBERES, REVA, EMDOS, Madrid, España
| | - Miquel Ferrer Monreal
- Servei de Pneumologia, Institut Clínic de Respiratori, Hospital Clínic de Barcelona, IDIBAPS, CIBERES (CB06/06/0028), Universitat de Barcelona, Barcelona, España
| | | | - Eva Lista Arias
- Servicio de Urgencias, Parc Taulí Hospital Universitari, Sabadell, Barcelona, España
| | | | | | | | - Mónica González Martínez
- Unidad de Sueño y Ventilación, Neumología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España
| | - Eva Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | | | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, España
| | - Arantxa Mas Serra
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi y Hospital General d'Hospitalet, Sant Joan Despí, Barcelona, España
| | | | - Candelaria de Haro López
- Área de Críticos, Corporació Sanitària i Universitària Parc Taulí. CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Sabadell, Barcelona, España
| | - Oriol Roca Gas
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona. CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Barcelona, España
| | - Ricard Ferrer Roca
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron. Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Institut de Recerca. CIBER de Enfermedades Respiratorias, CIBERES, Barcelona, España
| | - Antonio Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Madrid, España
| | - Carlos Ferrando Ortola
- Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, España
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Cinesi Gómez C, Peñuelas Rodríguez Ó, Luján Torné M, Egea Santaolalla C, Masa Jiménez JF, García Fernández J, Carratalá Perales JM, Heili-Frades SB, Ferrer Monreal M, de Andrés Nilsson JM, Lista Arias E, Sánchez Rocamora JL, Garrote JI, Zamorano Serrano MJ, González Martínez M, Farrero Muñoz E, Mediano San Andrés O, Rialp Cervera G, Mas Serra A, Hernández Martínez G, de Haro López C, Roca Gas O, Ferrer Roca R, Romero Berrocal A, Ferrando Ortola C. Clinical Consensus Recommendations Regarding Non-Invasive Respiratory Support in the Adult Patient with Acute Respiratory Failure Secondary to SARS-CoV-2 infection. Arch Bronconeumol 2020; 56:11-18. [PMID: 34629620 PMCID: PMC7270645 DOI: 10.1016/j.arbres.2020.03.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
La enfermedad por coronavirus 2019 (COVID-19) es una infección del tracto respiratorio causada por un nuevo coronavirus emergente que se reconoció por primera vez en Wuhan, China, en diciembre de 2019. Actualmente la Organización Mundial de la Salud (OMS) ha definido la infección como pandemia y existe una situación de emergencia sanitaria y social para el manejo de esta nueva infección. Mientras que la mayoría de las personas con COVID-19 desarrollan solo una enfermedad leve o no complicada, aproximadamente el 14% desarrollan una enfermedad grave que requiere hospitalización y oxígeno, y el 5% pueden requerir ingreso en una Unidad de Cuidados Intensivos. En casos severos, COVID-19 puede complicarse por el síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico y fracaso multiorgánico. Este documento de consenso se ha preparado sobre directrices basadas en evidencia desarrolladas por un panel multidisciplinario de profesionales médicos de cuatro sociedades científicas españolas (Sociedad Española de Medicina Intensiva y Unidades Coronarias [SEMICYUC], Sociedad Española de Neumología y Cirugía Torácica [SEPAR], Sociedad Española de Urgencias y Emergencias [SEMES], Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor [SEDAR]) con experiencia en el manejo clínico de pacientes con COVID-19 y otras infecciones virales, incluido el SARS, así como en sepsis y SDRA. El documento proporciona recomendaciones clínicas para el soporte respiratorio no invasivo (ventilación no invasiva, oxigenoterapia de alto flujo con cánula nasal) en cualquier paciente con presentación sospechada o confirmada de COVID-19 con insuficiencia respiratoria aguda. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos.
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Affiliation(s)
- César Cinesi Gómez
- Dirección General de Asistencia Sanitaria, Servicio Murciano de Salud. Director del Máster Oficial en Medicina de Urgencias y Emergencias, Murcia, España
| | - Óscar Peñuelas Rodríguez
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe. CIBER de Enfermedades Respiratorias, CIBERES, Getafe, Madrid, España
| | - Manel Luján Torné
- Servicio de Neumología, Hospital de Sabadell, Corporació Parc Taulí, Universitat Autònoma de Barcelona. Centro de Investigación Biomédica en Red (CIBERES), Sabadell, Barcelona, España.
| | | | - Juan Fernando Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara. CIBER de Enfermedades Respiratorias (CIBERES). Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, España
| | - Javier García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro, Madrid, España
| | - José Manuel Carratalá Perales
- Servicio de Urgencias, Unidad de Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-Fundación FISABIO), Alicante, España
| | - Sarah Béatrice Heili-Frades
- Jefe Asociado de Neumología, responsable de la UCIR, Hospital Universitario Fundación Jiménez Díaz. CIBERES, REVA, EMDOS, Madrid, España
| | - Miquel Ferrer Monreal
- Servei de Pneumologia, Institut Clínic de Respiratori, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, España
| | | | - Eva Lista Arias
- Servicio de Urgencias, Parc Taulí Hospital Universitari, Sabadell, Barcelona, España
| | | | | | | | - Mónica González Martínez
- Unidad de Sueño y Ventilación, Neumología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, España
| | - Eva Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | | | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, España
| | - Arantxa Mas Serra
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Hospital General d'Hospitalet, Sant Joan Despí, Barcelona, España
| | | | - Candelaria de Haro López
- Área de Críticos, Corporació Sanitària i Universitària Parc Taulí. CIBER Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Sabadell, Barcelona, España
| | - Oriol Roca Gas
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona. Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Barcelona, España
| | - Ricard Ferrer Roca
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Institut de Recerca. CIBER de Enfermedades Respiratorias, CIBERES, Barcelona, España
| | - Antonio Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Madrid, España
| | - Carlos Ferrando Ortola
- Jefe de Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, España
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Sundaram M, Ravikumar N, Bansal A, Nallasamy K, Basavaraja GV, Lodha R, Gupta D, Odena MP, Ashwath RNR, Jayashree M. Novel Coronavirus 2019 (2019-nCoV) Infection: Part II - Respiratory Support in the Pediatric Intensive Care Unit in Resource-limited Settings. Indian Pediatr 2020. [PMID: 32238613 PMCID: PMC7182733 DOI: 10.1007/s13312-020-1786-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The 2019-novel coronavirus predominantly affects the respiratory system with manifestations ranging from upper respiratory symptoms to full blown acute respiratory distress syndrome (ARDS). It is important to recognize the risk factors, categorize severity and provide early treatment. Use of high flow devices and non-invasive ventilation has been discouraged due to high chances of aerosol generation. Early intubation and mechanical ventilation areessential to prevent complications and worsening, especially in resource-limited settings with very few centers having expertise to manage critical cases. Hydrophobic viral filter in the ventilator circuit minimizes chances of transmission of virus. Strategies to manage ARDS in COVID-19 include low tidal volume ventilation with liberal sedation-analgesia. At the same time, prevention of transmission of the virus to healthcare workers is extremely important in the intensive care setting dealing with severe cases and requiring procedures generating aerosol. We, herein, provide guidance on non-invasive respiratory support, intubation and management of ARDS in a child with COVID-19.
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Affiliation(s)
- Manu Sundaram
- Division of Critical Care Medicine, Sidra Medicine, Doha, Qatar
| | - Namita Ravikumar
- Division of Pediatric Critical Care, Department of Paediatrics, Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Bansal
- Division of Pediatric Critical Care, Department of Paediatrics, Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Correspondence to: Dr Arun Bansal, Professor, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Karthi Nallasamy
- Division of Pediatric Critical Care, Department of Paediatrics, Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - G V Basavaraja
- Pediatric Intensive Care Unit, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Dhiren Gupta
- Pediatric Intensive Care Unit, Sir Ganga Ram Hospital, Delhi, India
| | - Marti Pons Odena
- Department of Pediatric Intensive Care, Sant Joan de Due Hospital, Barcelona, Spain
| | - R N Ram Ashwath
- Department of Pediatric Intensive Care, Manipal Hospital, Bangalore, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Department of Paediatrics, Advanced Paediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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17
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Metabolomic Profile of ARDS by Nuclear Magnetic Resonance Spectroscopy in Patients With H1N1 Influenza Virus Pneumonia. Shock 2019; 50:504-510. [PMID: 29293175 DOI: 10.1097/shk.0000000000001099] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The integrated analysis of changes in the metabolic profile could be critical for the discovery of biomarkers of lung injury, and also for generating new pathophysiological hypotheses and designing novel therapeutic targets for the acute respiratory distress syndrome (ARDS). This study aimed at developing a nuclear magnetic resonance (NMR)-based approach for the identification of the metabolomic profile of ARDS in patients with H1N1 influenza virus pneumonia. METHODS Serum samples from 30 patients (derivation set) diagnosed of H1N1 influenza virus pneumonia were analyzed by unsupervised principal component analysis to identify metabolic differences between patients with and without ARDS by NMR spectroscopy. A predictive model of partial least squares discriminant analysis (PLS-DA) was developed for the identification of ARDS. PLS-DA was trained with the derivation set and tested in another set of samples from 26 patients also diagnosed of H1N1 influenza virus pneumonia (validation set). RESULTS Decreased serum glucose, alanine, glutamine, methylhistidine and fatty acids concentrations, and elevated serum phenylalanine and methylguanidine concentrations, discriminated patients with ARDS versus patients without ARDS. PLS-DA model successfully identified the presence of ARDS in the validation set with a success rate of 92% (sensitivity 100% and specificity 91%). The classification functions showed a good correlation with the Sequential Organ Failure Assessment score (R = 0.74, P < 0.0001) and the PaO2/FiO2 ratio (R = 0.41, P = 0.03). CONCLUSIONS The serum metabolomic profile is sensitive and specific to identify ARDS in patients with H1N1 influenza A pneumonia. Future studies are needed to determine the role of NMR spectroscopy as a biomarker of ARDS.
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Megiddo I, Drabik D, Bedford T, Morton A, Wesseler J, Laxminarayan R. Investing in antibiotics to alleviate future catastrophic outcomes: What is the value of having an effective antibiotic to mitigate pandemic influenza? HEALTH ECONOMICS 2019; 28:556-571. [PMID: 30746802 DOI: 10.1002/hec.3867] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/08/2018] [Accepted: 12/10/2018] [Indexed: 05/22/2023]
Abstract
Over 95% of post-mortem samples from the 1918 pandemic, which caused 50 to 100 million deaths, showed bacterial infection complications. The introduction of antibiotics in the 1940s has since reduced the risk of bacterial infections, but growing resistance to antibiotics could increase the toll from future influenza pandemics if secondary bacterial infections are as serious as in 1918, or even if they are less severe. We develop a valuation model of the option to withhold wide use of an antibiotic until significant outbreaks such as pandemic influenza or foodborne diseases are identified. Using real options theory, we derive conditions under which withholding wide use is beneficial, and calculate the option value for influenza pandemic scenarios that lead to secondary infections with a resistant Staphylococcus aureus strain. We find that the value of withholding an effective novel oral antibiotic can be positive and significant unless the pandemic is mild and causes few secondary infections with the resistant strain or if most patients can be treated intravenously. Although the option value is sensitive to parameter uncertainty, our results suggest that further analysis on a case-by-case basis could guide investment in novel agents as well as strategies on how to use them.
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Affiliation(s)
- Itamar Megiddo
- Department of Management Science, University of Strathclyde, Glasgow, UK
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Dusan Drabik
- Agricultural Economics and Rural Policy Group, Wageningen University, Wageningen, The Netherlands
| | - Tim Bedford
- Department of Management Science, University of Strathclyde, Glasgow, UK
| | - Alec Morton
- Department of Management Science, University of Strathclyde, Glasgow, UK
| | - Justus Wesseler
- Agricultural Economics and Rural Policy Group, Wageningen University, Wageningen, The Netherlands
| | - Ramanan Laxminarayan
- Department of Management Science, University of Strathclyde, Glasgow, UK
- Center for Disease Dynamics, Economics & Policy, Washington, DC
- Princeton Environmental Institute, Princeton University, Princeton, New Jersey
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19
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Vanoni NM, Carugati M, Borsa N, Sotgiu G, Saderi L, Gori A, Mantero M, Aliberti S, Blasi F. Management of Acute Respiratory Failure Due to Community-Acquired Pneumonia: A Systematic Review. Med Sci (Basel) 2019; 7:medsci7010010. [PMID: 30646626 PMCID: PMC6359640 DOI: 10.3390/medsci7010010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 01/15/2023] Open
Abstract
Community-acquired pneumonia (CAP) is a leading cause of mortality worldwide. CAP mortality is driven by the development of sepsis and acute respiratory failure (ARF). We performed a systematic review of the available English literature published in the period 1 January 1997 to 31 August 2017 and focused on ARF in CAP. The database searches identified 189 articles—of these, only 29 were retained for data extraction. Of these 29 articles, 12 addressed ARF in CAP without discussing its ventilatory management, while 17 evaluated the ventilatory management of ARF in CAP. In the studies assessing the ventilatory management, the specific treatments addressed were: high-flow nasal cannula (HFNC) (n = 1), continuous positive airway pressure (n = 2), non-invasive ventilation (n = 9), and invasive mechanical ventilation (n = 5). When analyzed, non-invasive ventilation (NIV) success rates ranged from 20% to 76% and they strongly predicted survival, while NIV failure led to an increased risk of adverse outcome. In conclusion, ARF in CAP patients may require both ventilatory and non-ventilatory management. Further research is needed to better evaluate the use of NIV and HFNC in those patients. Alongside the prompt administration of antimicrobials, the potential use of steroids and the implementation of severity scores should also be considered.
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Affiliation(s)
- Nicolò Maria Vanoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, 20122 Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
| | - Manuela Carugati
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Infectious Diseases Unit, 20122 Milan, Italy.
- Division of Infectious Diseases, Duke University, 27710 Durham, NC, USA.
| | - Noemi Borsa
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, 20122 Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy.
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy.
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Infectious Diseases Unit, 20122 Milan, Italy.
| | - Marco Mantero
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, 20122 Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
| | - Stefano Aliberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, 20122 Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
| | - Francesco Blasi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Internal Medicine Department, Respiratory unit and Adult Cystic Fibrosis Center, 20122 Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
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MacIntyre CR, Chughtai AA, Barnes M, Ridda I, Seale H, Toms R, Heywood A. The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09. BMC Infect Dis 2018; 18:637. [PMID: 30526505 PMCID: PMC6286525 DOI: 10.1186/s12879-018-3548-0] [Citation(s) in RCA: 205] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/23/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of this study was to estimate the prevalence of pneumonia and secondary bacterial infections during the pandemic of influenza A(H1N1)pdm09. METHODS A systematic review was conducted to identify relevant literature in which clinical outcomes of pandemic influenza A(H1N1)pdm09 infection were described. Published studies (between 01/01/2009 and 05/07/2012) describing cases of fatal or hospitalised A(H1N1)pdm09 and including data on bacterial testing or co-infection. RESULTS Seventy five studies met the inclusion criteria. Fatal cases with autopsy specimen testing were reported in 11 studies, in which any co-infection was identified in 23% of cases (Streptococcus pneumoniae 29%). Eleven studies reported bacterial co-infection among hospitalised cases of A(H1N1)2009pdm with confirmed pneumonia, with a mean of 19% positive for bacteria (Streptococcus pneumoniae 54%). Of 16 studies of intensive care unit (ICU) patients, bacterial co-infection identified in a mean of 19% of cases (Streptococcus pneumoniae 26%). The mean prevalence of bacterial co-infection was 12% in studies of hospitalised patients not requiring ICU (Streptococcus pneumoniae 33%) and 16% in studies of paediatric patients hospitalised in general or pediatric intensive care unit (PICU) wards (Streptococcus pneumoniae 16%). CONCLUSION We found that few studies of the 2009 influenza pandemic reported on bacterial complications and testing. Of studies which did report on this, secondary bacterial infection was identified in almost one in four patients, with Streptococcus pneumoniae the most common bacteria identified. Bacterial complications were associated with serious outcomes such as death and admission to intensive care. Prevention and treatment of bacterial secondary infection should be an integral part of pandemic planning, and improved uptake of routine pneumococcal vaccination in adults with an indication may reduce the impact of a pandemic.
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Affiliation(s)
- Chandini Raina MacIntyre
- Biosecurity Program, The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, NSW 2052 Australia
| | - Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
| | - Michelle Barnes
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
| | - Iman Ridda
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
| | - Holly Seale
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
| | - Renin Toms
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
| | - Anita Heywood
- School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW 2052 Australia
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21
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Huízar-Hernández V, Arredondo A, Caballero M, Castro-Ríos A, Flores-Hernández S, Pérez-Padilla R, Reyes-Morales H. Decision-making Process by Users and Providers of Health Care Services During the AH1N1 Epidemic Influenza in Mexico: Lessons Learned and Challenges Ahead. Arch Med Res 2017; 48:276-283. [PMID: 28923330 DOI: 10.1016/j.arcmed.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 05/23/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to analyze, using a decision analysis approach, the probability of severity of illness due to delayed utilization of health services and inappropriate hospital medical treatment during the 2009 AH1N1 influenza epidemic in Mexico. METHODS Patients with influenza AH1N1 confirmed by the polymerase chain reaction (PCR) test from two hospitals in Mexico City, were included. Path methodology based upon literature and validated by clinical experts was followed. The probability for severe illness originated from delayed utilization of health services, delayed prescription of neuraminidase inhibitors (NAIs) and inappropriate use of antibiotics was assessed. FINDINGS Ninety-nine patients were analyzed, and 16% developed severe illness. Most patients received NAIs and 85.9% received antibiotics. Inappropriate use of antibiotics was observed in 70.7% of cases. Early utilization of services increased the likelihood of non-severe illness (cumulative probability CP = 0.56). The major cumulative probability for severe illness was observed when prescription of NAIs was delayed (CP = 0.19). CONCLUSION Delayed prescription of NAIs and irrational use of antibiotics are critical decisions for unfavorable outcomes in patients suffering influenza AH1N1.
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Affiliation(s)
- Víctor Huízar-Hernández
- Unidad de Cuidados Intensivos Respiratorios, Hospital General, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Armando Arredondo
- Centro de Investigación de Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Marta Caballero
- Facultad de Estudios Superiores, Universidad Autónoma del Estado de Morelos, Cuernavaca, Morelos, México
| | - Angélica Castro-Ríos
- Unidad de Investigación de Epidemiología Clínica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Sergio Flores-Hernández
- Centro de Evaluación y Encuestas de Investigación, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Rogelio Pérez-Padilla
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México
| | - Hortensia Reyes-Morales
- Centro de Información para Decisiones en Salud Pública, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
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22
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Huang SF, Fung CP, Perng DW, Wang FD. Effects of corticosteroid and neuraminidase inhibitors on survival in patients with respiratory distress induced by influenza virus. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:586-594. [DOI: 10.1016/j.jmii.2015.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/20/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
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23
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Shah NS, Greenberg JA, McNulty MC, Gregg KS, Riddell J, Mangino JE, Weber DM, Hebert CL, Marzec NS, Barron MA, Chaparro-Rojas F, Restrepo A, Hemmige V, Prasidthrathsint K, Cobb S, Herwaldt L, Raabe V, Cannavino CR, Hines AG, Bares SH, Antiporta PB, Scardina T, Patel U, Reid G, Mohazabnia P, Kachhdiya S, Le BM, Park CJ, Ostrowsky B, Robicsek A, Smith BA, Schied J, Bhatti MM, Mayer S, Sikka M, Murphy-Aguilu I, Patwari P, Abeles SR, Torriani FJ, Abbas Z, Toya S, Doktor K, Chakrabarti A, Doblecki-Lewis S, Looney DJ, David MZ. Bacterial and viral co-infections complicating severe influenza: Incidence and impact among 507 U.S. patients, 2013-14. J Clin Virol 2016; 80:12-9. [PMID: 27130980 PMCID: PMC7185824 DOI: 10.1016/j.jcv.2016.04.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 12/02/2022]
Abstract
22.5% of adult patients with H1N1 developed bacterial co-infection. Staphylococcus aureus was the most common cause of co-infection. Bacterial and viral co-infections were associated with death in bivariate. Patients with a bacterial co-infection had greater use of resources.
Background Influenza acts synergistically with bacterial co-pathogens. Few studies have described co-infection in a large cohort with severe influenza infection. Objectives To describe the spectrum and clinical impact of co-infections. Study design Retrospective cohort study of patients with severe influenza infection from September 2013 through April 2014 in intensive care units at 33 U.S. hospitals comparing characteristics of cases with and without co-infection in bivariable and multivariable analysis. Results Of 507 adult and pediatric patients, 114 (22.5%) developed bacterial co-infection and 23 (4.5%) developed viral co-infection. Staphylococcus aureus was the most common cause of co-infection, isolated in 47 (9.3%) patients. Characteristics independently associated with the development of bacterial co-infection of adult patients in a logistic regression model included the absence of cardiovascular disease (OR 0.41 [0.23–0.73], p = 0.003), leukocytosis (>11 K/μl, OR 3.7 [2.2–6.2], p < 0.001; reference: normal WBC 3.5–11 K/μl) at ICU admission and a higher ICU admission SOFA score (for each increase by 1 in SOFA score, OR 1.1 [1.0–1.2], p = 0.001). Bacterial co-infections (OR 2.2 [1.4–3.6], p = 0.001) and viral co-infections (OR 3.1 [1.3–7.4], p = 0.010) were both associated with death in bivariable analysis. Patients with a bacterial co-infection had a longer hospital stay, a longer ICU stay and were likely to have had a greater delay in the initiation of antiviral administration than patients without co-infection (p < 0.05) in bivariable analysis. Conclusions Bacterial co-infections were common, resulted in delay of antiviral therapy and were associated with increased resource allocation and higher mortality.
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Affiliation(s)
- Nirav S Shah
- Department of Medicine, University of Chicago, Chicago, IL, United States.
| | - Jared A Greenberg
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Moira C McNulty
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Kevin S Gregg
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - James Riddell
- Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Julie E Mangino
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Devin M Weber
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Courtney L Hebert
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States; Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Natalie S Marzec
- Department of Family Medicine, University of Colorado Denver, Denver, CO, United States
| | - Michelle A Barron
- Department of Medicine, University of Colorado Denver, Denver, CO, United States
| | | | - Alejandro Restrepo
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Vagish Hemmige
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | | | - Sandra Cobb
- Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Loreen Herwaldt
- Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Vanessa Raabe
- Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, CA, United States
| | - Christopher R Cannavino
- Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, CA, United States
| | - Andrea Green Hines
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Sara H Bares
- Department of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Philip B Antiporta
- Department of Medicine, Loyola University Medical Center, Maywood, IL, United States; Department of Medicine, Edward Hines VA Hospital, Maywood, IL, United States
| | - Tonya Scardina
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL, United States
| | - Ursula Patel
- Department of Pharmacy, Edward Hines VA Hospital, Maywood, IL, United States
| | - Gail Reid
- Department of Medicine, Loyola University Medical Center, Maywood, IL, United States; Department of Medicine, Edward Hines VA Hospital, Maywood, IL, United States
| | - Parvin Mohazabnia
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Suresh Kachhdiya
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Binh-Minh Le
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Connie J Park
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Belinda Ostrowsky
- Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ari Robicsek
- Department of Medicine, University of Chicago, Chicago, IL, United States; Department of Medicine, Northshore University HealthSystem, Evanston, IL, United States
| | - Becky A Smith
- Department of Medicine, Northshore University HealthSystem, Evanston, IL, United States
| | - Jeanmarie Schied
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
| | - Micah M Bhatti
- Department of Pediatrics, University of Chicago, Chicago, IL, United States
| | - Stockton Mayer
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States; Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Monica Sikka
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States; Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Ivette Murphy-Aguilu
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States; Department of Medicine, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Priti Patwari
- Department of Medicine, Community Care Networks, Inc., Munster, IN, United States
| | - Shira R Abeles
- Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Francesca J Torriani
- Department of Medicine, University of California San Diego, San Diego, CA, United States
| | - Zainab Abbas
- Department of Medicine, Methodist Hospitals, Merrillville, IN, United States
| | - Sophie Toya
- Department of Medicine, Methodist Hospitals, Merrillville, IN, United States
| | - Katherine Doktor
- Department of Medicine, University of Miami/Jackson Health System, Miami, FL, United States
| | - Anindita Chakrabarti
- Department of Medicine, University of Miami/Jackson Health System, Miami, FL, United States
| | - Susanne Doblecki-Lewis
- Department of Medicine, University of Miami/Jackson Health System, Miami, FL, United States
| | - David J Looney
- Department of Medicine, VA San Diego/University of California San Diego, San Diego, CA, United States
| | - Michael Z David
- Department of Medicine, University of Chicago, Chicago, IL, United States; Department of Pediatrics, University of Chicago, Chicago, IL, United States
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Reddy KP, Bajwa EK, Parker RA, Onderdonk AB, Walensky RP. Relationship Between Upper Respiratory Tract Influenza Test Result and Clinical Outcomes Among Critically Ill Influenza Patients. Open Forum Infect Dis 2016; 3:ofw023. [PMID: 26966696 PMCID: PMC4784015 DOI: 10.1093/ofid/ofw023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/31/2016] [Indexed: 12/30/2022] Open
Abstract
Among critically ill patients with lower respiratory tract (LRT)-confirmed influenza, we retrospectively observed worse 28-day clinical outcomes in upper respiratory tract (URT)-negative versus URT-positive subjects. This finding may reflect disease progression and highlights the need for influenza testing of both URT and LRT specimens to improve diagnostic yield and possibly inform prognosis.
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Affiliation(s)
- Krishna P Reddy
- Medical Practice Evaluation Center; Division of Pulmonary and Critical Care Medicine; Division of Pulmonary and Critical Care Medicine; Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center; Harvard Medical School, Boston, Massachusetts
| | - Ednan K Bajwa
- Division of Pulmonary and Critical Care Medicine; Harvard Medical School, Boston, Massachusetts
| | - Robert A Parker
- Medical Practice Evaluation Center; Division of General Internal Medicine; Biostatistics Center; Harvard Medical School, Boston, Massachusetts
| | | | - Rochelle P Walensky
- Medical Practice Evaluation Center; Division of General Internal Medicine; Division of Infectious Disease, Massachusetts General Hospital; Division of Infectious Disease, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
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Esquinas AM, Egbert Pravinkumar S, Scala R, Gay P, Soroksky A, Girault C, Han F, Hui DS, Papadakos PJ, Ambrosino N. Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review. Eur Respir Rev 2015; 23:427-38. [PMID: 25445941 DOI: 10.1183/09059180.00009413] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The aim of this article was to review the role of noninvasive ventilation (NIV) in acute pulmonary infectious diseases, such as severe acute respiratory syndrome (SARS), H1N1 and tuberculosis, and to assess the risk of disease transmission with the use of NIV from patients to healthcare workers. We performed a clinical review by searching Medline and EMBASE. These databases were searched for articles on "clinical trials" and "randomised controlled trials". The keywords selected were non-invasive ventilation pulmonary infections, influenza-A (H1N1), SARS and tuberculosis. These terms were cross-referenced with the following keywords: health care workers, airborne infections, complications, intensive care unit and pandemic. The members of the International NIV Network examined the major results regarding NIV applications and SARS, H1N1 and tuberculosis. Cross-referencing mechanical ventilation with SARS yielded 76 studies, of which 10 studies involved the use of NIV and five were ultimately selected for inclusion in this review. Cross-referencing with H1N1 yielded 275 studies, of which 27 involved NIV. Of these, 22 were selected for review. Cross-referencing with tuberculosis yielded 285 studies, of which 15 involved NIV and from these seven were selected. In total 34 studies were selected for this review. NIV, when applied early in selected patients with SARS, H1N1 and acute pulmonary tuberculosis infections, can reverse respiratory failure. There are only a few reports of infectious disease transmission among healthcare workers.
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Affiliation(s)
- Antonio M Esquinas
- Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain. Dept of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Pulmonary and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy. Dept of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA. General Intensive Care Unit, Assaf Harofeh Medical Center, Ramat Aviv, Israel. Dept of Medical Intensive Care, Charles Nicolle Rouen University Hospital, UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France. Dept of Pulmonary Medicine, The People's Hospital, Beijing University, Beijing, China. Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China. Critical Care, University of Rochester, Rochester NY, USA. Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Dept, University Hospital Pisa, Pisa, Italy. For a full list of the International NIV Network collaborators see the Acknowledgements
| | - S Egbert Pravinkumar
- Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain. Dept of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Pulmonary and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy. Dept of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA. General Intensive Care Unit, Assaf Harofeh Medical Center, Ramat Aviv, Israel. Dept of Medical Intensive Care, Charles Nicolle Rouen University Hospital, UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France. Dept of Pulmonary Medicine, The People's Hospital, Beijing University, Beijing, China. Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China. Critical Care, University of Rochester, Rochester NY, USA. Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Dept, University Hospital Pisa, Pisa, Italy. For a full list of the International NIV Network collaborators see the Acknowledgements
| | - Raffaele Scala
- Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain. Dept of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Pulmonary and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy. Dept of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA. General Intensive Care Unit, Assaf Harofeh Medical Center, Ramat Aviv, Israel. Dept of Medical Intensive Care, Charles Nicolle Rouen University Hospital, UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France. Dept of Pulmonary Medicine, The People's Hospital, Beijing University, Beijing, China. Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China. Critical Care, University of Rochester, Rochester NY, USA. Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Dept, University Hospital Pisa, Pisa, Italy. For a full list of the International NIV Network collaborators see the Acknowledgements
| | - Peter Gay
- Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain. Dept of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Pulmonary and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy. Dept of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA. General Intensive Care Unit, Assaf Harofeh Medical Center, Ramat Aviv, Israel. Dept of Medical Intensive Care, Charles Nicolle Rouen University Hospital, UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France. Dept of Pulmonary Medicine, The People's Hospital, Beijing University, Beijing, China. Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China. Critical Care, University of Rochester, Rochester NY, USA. Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Dept, University Hospital Pisa, Pisa, Italy. For a full list of the International NIV Network collaborators see the Acknowledgements
| | - Arie Soroksky
- Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain. Dept of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Pulmonary and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy. Dept of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA. General Intensive Care Unit, Assaf Harofeh Medical Center, Ramat Aviv, Israel. Dept of Medical Intensive Care, Charles Nicolle Rouen University Hospital, UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France. Dept of Pulmonary Medicine, The People's Hospital, Beijing University, Beijing, China. Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China. Critical Care, University of Rochester, Rochester NY, USA. Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Dept, University Hospital Pisa, Pisa, Italy. For a full list of the International NIV Network collaborators see the Acknowledgements
| | - Christophe Girault
- Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain. Dept of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Pulmonary and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy. Dept of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA. General Intensive Care Unit, Assaf Harofeh Medical Center, Ramat Aviv, Israel. Dept of Medical Intensive Care, Charles Nicolle Rouen University Hospital, UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France. Dept of Pulmonary Medicine, The People's Hospital, Beijing University, Beijing, China. Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China. Critical Care, University of Rochester, Rochester NY, USA. Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Dept, University Hospital Pisa, Pisa, Italy. For a full list of the International NIV Network collaborators see the Acknowledgements
| | - Fang Han
- Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain. Dept of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Pulmonary and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy. Dept of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA. General Intensive Care Unit, Assaf Harofeh Medical Center, Ramat Aviv, Israel. Dept of Medical Intensive Care, Charles Nicolle Rouen University Hospital, UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France. Dept of Pulmonary Medicine, The People's Hospital, Beijing University, Beijing, China. Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China. Critical Care, University of Rochester, Rochester NY, USA. Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Dept, University Hospital Pisa, Pisa, Italy. For a full list of the International NIV Network collaborators see the Acknowledgements
| | - David S Hui
- Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain. Dept of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Pulmonary and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy. Dept of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA. General Intensive Care Unit, Assaf Harofeh Medical Center, Ramat Aviv, Israel. Dept of Medical Intensive Care, Charles Nicolle Rouen University Hospital, UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France. Dept of Pulmonary Medicine, The People's Hospital, Beijing University, Beijing, China. Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China. Critical Care, University of Rochester, Rochester NY, USA. Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Dept, University Hospital Pisa, Pisa, Italy. For a full list of the International NIV Network collaborators see the Acknowledgements
| | - Peter J Papadakos
- Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain. Dept of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Pulmonary and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy. Dept of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA. General Intensive Care Unit, Assaf Harofeh Medical Center, Ramat Aviv, Israel. Dept of Medical Intensive Care, Charles Nicolle Rouen University Hospital, UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France. Dept of Pulmonary Medicine, The People's Hospital, Beijing University, Beijing, China. Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China. Critical Care, University of Rochester, Rochester NY, USA. Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Dept, University Hospital Pisa, Pisa, Italy. For a full list of the International NIV Network collaborators see the Acknowledgements
| | - Nicolino Ambrosino
- Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain. Dept of Critical Care, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Pulmonary and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy. Dept of Pulmonary, Critical Care and Sleep Medicine, Mayo Clinic, Rochester, MN, USA. General Intensive Care Unit, Assaf Harofeh Medical Center, Ramat Aviv, Israel. Dept of Medical Intensive Care, Charles Nicolle Rouen University Hospital, UPRES EA 3830-IRIB, Institute for Biomedical Research, Rouen University, Rouen, France. Dept of Pulmonary Medicine, The People's Hospital, Beijing University, Beijing, China. Dept of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China. Critical Care, University of Rochester, Rochester NY, USA. Pulmonary and Respiratory Intensive Care Unit, Cardio-Thoracic Dept, University Hospital Pisa, Pisa, Italy. For a full list of the International NIV Network collaborators see the Acknowledgements
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Nermin KG, Remzi I, Zeynep A, Ilker C, Meltem OT, Guven O, Ferda K, Halis A. A retrospective evaluation of critically ill patients infected with H1N1 influenza A virus in Bursa, Turkey, during the 2009-2010 pandemic. Afr Health Sci 2015; 15:352-9. [PMID: 26124779 DOI: 10.4314/ahs.v15i2.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND H1N1 influenza A virus infections were first reported in April 2009 and spread rapidly, resulting in mortality worldwide. The aim of this study was to evaluate patients with H1N1 infection treated in the intensive care unit (ICU) in Bursa, Turkey. METHODS Demographic characteristics, clinical features, and outcome relating to H1N1 infection were retrospectively analysed in patients treated in the ICU. RESULTS Twenty-three cases of H1N1 infection were treated in the ICU. The mean age of patients was 37 years range: (17-82). Fifteen patients were female (65.2%). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 19 range: (5-39). The most common symptoms were dyspnea (73.9%), fever (69.6%), and cough (60.9%). Mechanical ventilation was required for all patients. Oseltamivir and antibiotics were administered to all patients. Six (26.1%) patients died. APACHE II scores were higher in the deceased 28.5 range: [16-39] vs. 14 range: [5-28] in survivors; p = 0.013). CONCLUSION When compared to the literature, the demographic, epidemiological, and clinical characteristics were similar in the cases we encountered. The mortality rate was high despite the use of appropriate treatment. We believe that the high mortality is related to higher APACHE II scores. The H1N1 virus should be considered in community acquired pneumonia, especially in younger patients presenting with severe pneumonia.
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Affiliation(s)
- Kelebek Girgin Nermin
- Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation
| | - Iscimen Remzi
- Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation
| | - Akogul Zeynep
- Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation
| | - Cimen Ilker
- Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation
| | - Oner Torlar Meltem
- Uludag University, School of Medicine, Department of Microbiology and Infectious Disease
| | - Ozkaya Guven
- Uludag University, School of Medicine, Department of Biostatistics
| | - Kahveci Ferda
- Uludag University, School of Medicine, Department of Anaesthesiology and Reanimation
| | - Akalin Halis
- Uludag University, School of Medicine, Department of Microbiology and Infectious Disease
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27
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Do corticosteroids reduce the mortality of influenza A (H1N1) infection? A meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:46. [PMID: 25888424 PMCID: PMC4348153 DOI: 10.1186/s13054-015-0764-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 01/22/2015] [Indexed: 02/07/2023]
Abstract
Introduction Corticosteroids are used empirically in influenza A (H1N1) treatment despite lack of clear evidence for effective treatment. This study aims to assess the efficacy of corticosteroids treatment for H1N1 infection. Methods Systematic review and meta-analysis were used to estimate the efficacy of corticosteroids for the prevention of mortality in H1N1 infection. Databases searched included MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Clinical Trials and so on, and bibliographies of retrieved articles, from April 2009 to October 2014. We included both cohort studies and case-control studies reported in English or Chinese that compared treatment effects between corticosteroids and non-corticosteroids therapy in inpatients with H1N1 virus infection. Cohort studies employed mortality as outcome, and case-control studies employed deaths as cases and survivors as controls; both were assessed in this meta-analysis. Results In total twenty-three eligible studies were included. Both cohort studies (nine studies, n = 1,405) and case-control studies (14 studies, n = 4,700) showed a similar trend toward increased mortality (cohort studies relative risk was 1.85 with 95% confidence interval (CI) 1.46 to 2.33; case-control studies odds ratio was 4.22 with 95% CI 3.10 to 5.76). The results from both subgroup analyses and sensitive analyses were consistent with each other, showing that steroid treatment is associated with mortality. However, considering the fact that corticosteroids were tend to be used in sickest case-patients and heterogeneity was observed between studies, we cannot make a solid conclusion. Conclusions Available evidence did not support the use of corticosteroids as standard care for patients with severe influenza. We conclude that further research is required. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-0764-5) contains supplementary material, which is available to authorized users.
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Abstract
Viruses are a common and important cause of severe community-acquired pneumonia, and may lead to severe respiratory disease and admission to the intensive care unit. Influenza is the most common virus associated with severe viral pneumonia, although other important causes include respiratory syncytial virus, adenovirus, metapneumonia virus, and coronaviruses. Viral pneumonias tend to have a seasonal predilection and are often preceded by a typical viral prodrome. This article focuses on severe influenza pneumonia, including the 2009 H1N1 pandemic, and briefly discusses other causes of severe respiratory disease of viral etiology.
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Affiliation(s)
- Clare D Ramsey
- Section of Respiratory Medicine, Department of Medicine, University of Manitoba, RS 314, 810 Sherbrook Street, Winnipeg, Manitoba R3A 1R8, Canada; Section of Critical Care, Department of Medicine, University of Manitoba, GC 425, 820 Sherbrook Street, Winnipeg, Manitoba R3T 2N2, Canada; Department of Community Health Sciences, University of Manitoba, S113, 750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada.
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Ventilatory Strategy Used for Management of Acute Respiratory Failure Due to Novel Influenza A(H1N1) Infection. NONINVASIVE VENTILATION IN HIGH-RISK INFECTIONS AND MASS CASUALTY EVENTS 2014. [PMCID: PMC7120036 DOI: 10.1007/978-3-7091-1496-4_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The first cases of the novel influenza A(H1N1) virus were reported in April 2009, especially in Mexico and the United States [1, 2]. The disease spread rapidly, becoming a pandemic by June 2009. On August 21, 2009, a total of 177 reported cases of novel influenza 182.166 A(H1N1) infection, of which 1,799 were fatal [2]. It has been observed in animal studies that the novel influenza virus A has a high replication rate in lung tissue, with a great capacity to invade the lower respiratory tract in humans, causing especially acute fulminant respiratory failure.
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Esquinas AM. Noninvasive Mechanical Ventilation for Hypoxemic Respiratory Failure-Related Infectious Diseases. NONINVASIVE VENTILATION IN HIGH-RISK INFECTIONS AND MASS CASUALTY EVENTS 2014. [PMCID: PMC7121750 DOI: 10.1007/978-3-7091-1496-4_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The strict range of applicability of noninvasive ventilation (NIV)—which had been applied only to patients with an exacerbation of chronic obstructive pulmonary disease (COPD) or acute cardiogenic pulmonary edema (ACPO)—has been extended during the last two decades.
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Affiliation(s)
- Antonio M. Esquinas
- Intensive Care & Non Invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain
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31
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Esquinas AM. Noninvasive Mechanical Ventilation in Patients with High-Risk Infections and Mass Casualties in Acute Respiratory Failure: Pediatric Perspective. NONINVASIVE VENTILATION IN HIGH-RISK INFECTIONS AND MASS CASUALTY EVENTS 2014. [PMCID: PMC7121261 DOI: 10.1007/978-3-7091-1496-4_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Respiratory problems are common symptoms in children and common reason for visits to the pediatric emergency department (PED) and admission to the pediatric intensive care unit (PICU). Although the great majority of cases are benign and self-limited, requiring no intervention, some patients need respiratory support. Invasive mechanical ventilation (IMV) is a critical intervention in many cases of acute respiratory failure (ARF), but there are absolute risks associated with endotracheal intubation (ETI). On the other hand, noninvasive ventilation (NIV) is an extremely valuable alternative to IMV. A major reason for the increasing use of NIV has been the desire to avoid the complications of IMV. It is generally much safer than IMV and has been shown to decrease resource utilization. Its use also avoids the complications and side effects associated with ETI, including upper airway trauma, laryngeal swelling, postextubation vocal cord dysfunction, nosocomial infections, and ventilator-associated pneumonia. There are a number of advantages of NIV including leaving the upper airway intact, preserving the natural defense mechanisms of the upper airways, decreasing the need for sedation, maintaining the ability to talk while undergoing NIV, and reducing the length of hospitalization and its associated costs [1–3].
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Affiliation(s)
- Antonio M. Esquinas
- Intensive Care & Non Invasive Ventilatory Unit, Hospital Morales Meseguer, Murcia, Spain
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Marty FM, Man CY, van der Horst C, Francois B, Garot D, Mánez R, Thamlikitkul V, Lorente JA, Alvarez-Lerma F, Brealey D, Zhao HH, Weller S, Yates PJ, Peppercorn AF. Safety and pharmacokinetics of intravenous zanamivir treatment in hospitalized adults with influenza: an open-label, multicenter, single-arm, phase II study. J Infect Dis 2013; 209:542-50. [PMID: 23983212 PMCID: PMC4047294 DOI: 10.1093/infdis/jit467] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background. Intravenous zanamivir is a neuraminidase inhibitor suitable for treatment of hospitalized patients with severe influenza. Methods. Patients were treated with intravenous zanamivir 600 mg twice daily, adjusted for renal impairment, for up to 10 days. Primary outcomes included adverse events (AEs), and clinical/laboratory parameters. Pharmacokinetics, viral load, and disease course were also assessed. Results. One hundred thirty patients received intravenous zanamivir (median, 5 days; range, 1–11) a median of 4.5 days (range, 1–7) after onset of influenza; 83% required intensive care. The most common influenza type/subtype was A/H1N1pdm09 (71%). AEs and serious AEs were reported in 85% and 34% of patients, respectively; serious AEs included bacterial pulmonary infections (8%), respiratory failure (7%), sepsis or septic shock (5%), and cardiogenic shock (5%). No drug-related trends in safety parameters were identified. Protocol-defined liver events were observed in 13% of patients. The 14- and 28-day all-cause mortality rates were 13% and 17%. No fatalities were considered zanamivir related. Pharmacokinetic data showed dose adjustments for renal impairment yielded similar zanamivir exposures. Ninety-three patients, positive at baseline for influenza by quantitative polymerase chain reaction, showed a median decrease in viral load of 1.42 log10 copies/mL after 2 days of treatment. Conclusions. Safety, pharmacokinetic and clinical outcome data support further investigation of intravenous zanamivir. Clinical Trials Registration NCT01014988.
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Affiliation(s)
- Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
Non-invasive ventilation refers to a number of respiratory support strategies commonly used in critical care settings. This paper describes the principles of non-invasive ventilation, the practicalities of its use and the evidence for its use in a number of common acute conditions.
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Affiliation(s)
- A M Cross
- Box Hill Hospital, Box Hill, Victoria, Australia.
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Kojicić M, Kovacević P, Bajramović N, Batranović U, Vidović J, Aganović K, Gavrilović S, Zlojutro B, Thiery G. Characteristics and outcome of mechanically ventilated patients with 2009 H1N1 influenza in Bosnia and Herzegovina and Serbia: impact of newly established multidisciplinary intensive care units. Croat Med J 2013; 53:620-6. [PMID: 23275328 PMCID: PMC3541588 DOI: 10.3325/cmj.2012.53.620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim To describe characteristics and outcome of mechanically ventilated patients admitted to three newly established intensive care units (ICU) in Bosnia-Herzegovina and Serbia for 2009 H1N1 influenza infection. Methods The retrospective observational study included all mechanically ventilated adult patients of three university-affiliated hospitals between November 1, 2009 and March 1 2010 who had 2009 H1N1 influenza infection confirmed by real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR) from nasopharyngeal swab specimens and respiratory secretions. Results The study included 50 patients, 31 male (62%), aged 43 ± 13 years. Median time from hospital to ICU admission was 1 day (range 1-2). Sixteen patients (30%) presented with one or more chronic medical condition: 8 (16%) with chronic lung disease, 5 (10%) with chronic heart failure, and 3 (6%) with diabetes mellitus. Thirty-two (64%) were obese. Forty-eight patients (96%) experienced acute respiratory distress syndrome (ARDS), 28 (56%) septic shock, and 27 (54%) multiorgan failure. Forty-five patients (90%) were intubated and mechanically ventilated, 5 received non-invasive mechanical ventilation, 7 (14%) high-frequency oscillatory ventilation, and 7 (14%) renal replacement therapy. The median duration of mechanical ventilation was 7 (4-14) days. Hospital mortality was 52%.
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Affiliation(s)
- Marija Kojicić
- Medical Intensive Care Unit, The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
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High Success and Low Mortality Rates With Early Use of Noninvasive Ventilation in Influenza A H1N1 Pneumonia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2013. [DOI: 10.1097/ipc.0b013e31828264d8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Cho JL, Roche MI, Sandall B, Brass AL, Seed B, Xavier RJ, Medoff BD. Enhanced Tim3 activity improves survival after influenza infection. THE JOURNAL OF IMMUNOLOGY 2012; 189:2879-89. [PMID: 22875804 DOI: 10.4049/jimmunol.1102483] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Influenza is a major cause of morbidity and mortality in the United States. Studies have shown that excessive T cell activity can mediate pneumonitis in the setting of influenza infection, and data from the 2009 H1N1 pandemic indicate that critical illness and respiratory failure postinfection were associated with greater infiltration of the lungs with CD8+ T cells. T cell Ig and mucin domain 3 (Tim3) is a negative regulator of Th1/Tc1-type immune responses. Activation of Tim3 on effector T cells has been shown to downregulate proliferation, cell-mediated cytotoxicity, and IFN-γ production, as well as induce apoptosis. In this article, we demonstrate that deletion of the terminal cytoplasmic domain of the Tim3 gene potentiates its ability to downregulate Tc1 inflammation, and that this enhanced Tim3 activity is associated with decreased phosphorylation of the TCR-CD3ζ-chain. We then show that mice with this Tim3 mutation infected with influenza are protected from morbidity and mortality without impairment in viral clearance or functional heterotypic immunity. This protection is associated with decreased CD8+ T cell proliferation and decreased production of inflammatory cytokines, including IFN-γ. Furthermore, the Tim3 mutation was protective against mortality in a CD8+ T cell-specific model of pneumonitis. These data suggest that Tim3 could be targeted to prevent immunopathology during influenza infection and demonstrate a potentially novel signaling mechanism used by Tim3 to downregulate the Tc1 response.
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Affiliation(s)
- Josalyn L Cho
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Boston, MA 02114, USA
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Cillóniz C, Ewig S, Menéndez R, Ferrer M, Polverino E, Reyes S, Gabarrús A, Marcos MA, Cordoba J, Mensa J, Torres A. Bacterial co-infection with H1N1 infection in patients admitted with community acquired pneumonia. J Infect 2012; 65:223-30. [PMID: 22543245 PMCID: PMC7132402 DOI: 10.1016/j.jinf.2012.04.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 03/16/2012] [Accepted: 04/21/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bacterial co-infection is an important contributor to morbidity and mortality during influenza pandemics .We investigated the incidence, risk factors and outcome of patients with influenza A H1N1 pneumonia and bacterial co-infection. METHODS Prospective observational study of consecutive hospitalized patients with influenza A H1N1 virus and community-acquired pneumonia (CAP). We compared cases with and without bacterial co-infection. RESULTS The incidence of influenza A H1N1 infection in CAP during the pandemic period was 19% (n, 667). We studied 128 patients; 42(33%) had bacterial co-infection. The most frequently isolated bacterial pathogens were Streptococcus pneumoniae (26, 62%) and Pseudomonas aeruginosa (6, 14%). Predictors for bacterial co-infection were chronic obstructive pulmonary disease (COPD) and increase of platelets count. The hospital mortality was 9%. Factors associated with mortality were age ≥ 65 years, presence of septic shock and the need for mechanical ventilation. Although patients with bacterial co-infection presented with higher Pneumonia Severity Index risk class, hospital mortality was similar to patients without bacterial co-infection (7% vs. 11%, respectively, p = 0.54). CONCLUSION Bacterial co-infection was frequent in influenza A H1N1 pneumonia, with COPD and increased platelet count as the main predictors. Although associated with higher severe scales at admission, bacterial co-infection did not influence mortality of these patients.
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Affiliation(s)
- Catia Cillóniz
- Department of Pneumology, Institut del Tórax, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Spain
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Balanzat AM, Hertlein C, Apezteguia C, Bonvehi P, Cámera L, Gentile A, Rizzo O, Gómez-Carrillo M, Coronado F, Azziz-Baumgartner E, Chávez PR, Widdowson MA. An analysis of 332 fatalities infected with pandemic 2009 influenza A (H1N1) in Argentina. PLoS One 2012; 7:e33670. [PMID: 22506006 PMCID: PMC3323608 DOI: 10.1371/journal.pone.0033670] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 02/14/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The apparent high number of deaths in Argentina during the 2009 pandemic led to concern that the influenza A H1N1pdm disease was different there. We report the characteristics and risk factors for influenza A H1N1pdm fatalities. METHODS We identified laboratory-confirmed influenza A H1N1pdm fatalities occurring during June-July 2009. Physicians abstracted data on age, sex, time of onset of illness, medical history, clinical presentation at admission, laboratory, treatment, and outcomes using standardize questionnaires. We explored the characteristics of fatalities according to their age and risk group. RESULTS Of 332 influenza A H1N1pdm fatalities, 226 (68%) were among persons aged <50 years. Acute respiratory failure was the leading cause of death. Of all cases, 249 (75%) had at least one comorbidity as defined by Advisory Committee on Immunization Practices. Obesity was reported in 32% with data and chronic pulmonary disease in 28%. Among the 40 deaths in children aged <5 years, chronic pulmonary disease (42%) and neonatal pathologies (35%) were the most common co-morbidities. Twenty (6%) fatalities were among pregnant or postpartum women of which only 47% had diagnosed co-morbidities. Only 13% of patients received antiviral treatment within 48 hours of symptom onset. None of children aged <5 years or the pregnant women received antivirals within 48 h of symptom onset. As the pandemic progressed, the time from symptom-onset to medical care and to antiviral treatment decreased significantly among case-patients who subsequently died (p<0.001). CONCLUSION Persons with co-morbidities, pregnant and who received antivirals late were over-represented among influenza A H1N1pdm deaths in Argentina, though timeliness of antiviral treatment improved during the pandemic.
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Affiliation(s)
- Ana M Balanzat
- National Ministry of Health of Argentina, Buenos Aires, Argentina.
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Roncon-Albuquerque R, Basílio C, Figueiredo P, Silva S, Mergulhão P, Alves C, Veiga R, Castelo-Branco S, Paiva L, Santos L, Honrado T, Dias C, Oliveira T, Sarmento A, Mota AM, Paiva JA. Portable miniaturized extracorporeal membrane oxygenation systems for H1N1-related severe acute respiratory distress syndrome: a case series. J Crit Care 2012; 27:454-63. [PMID: 22386225 DOI: 10.1016/j.jcrc.2012.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 01/17/2012] [Accepted: 01/22/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND Technological advances improved the practice of "modern" extracorporeal membrane oxygenation (ECMO). In the present report, we describe the experience of a referral ECMO center using portable miniaturized ECMO systems for H1N1-related severe acute respiratory distress syndrome (ARDS). METHODS An observational study of all patients with H1N1-associated ARDS treated with ECMO in Hospital S. João (Porto, Portugal) between November 2009 and April 2011 was performed. Extracorporeal membrane oxygenation support was established using either ELS or Cardiohelp systems (Maquet-Cardiopulmonary-AG, Hirrlingen, Germany). RESULTS Ten adult patients with severe ARDS secondary to H1N1 infection (Pao(2)/fraction of inspired oxygen, 69 mm Hg [56-84]; Murray score, 3.5 [3.5-3.8]) were included, and 60% survived to hospital discharge. Five patients were uneventfully transferred on ECMO from referring hospitals to our center by ambulance. Six patients were treated during the first postpandemic influenza season. All patients were treated with oseltamivir, and 1 received in addition zanamivir. Four patients received corticosteroids. Nosocomial infection was the most common complication (40%). Of the 4 deaths, 2 were caused by hemorrhagic shock; 1, by irreversible multiple organ failure; and 1, by refractory septic shock. CONCLUSION In our experience, ECMO support was a valuable therapeutic option for H1N1-related severe ARDS. The use of portable miniaturized systems allowed urgent rescue of patients from referring hospitals and safe interhospital and intrahospital transport during ECMO support.
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Rodríguez A, Alvarez-Rocha L, Sirvent JM, Zaragoza R, Nieto M, Arenzana A, Luque P, Socías L, Martín M, Navarro D, Camarena J, Lorente L, Trefler S, Vidaur L, Solé-Violán J, Barcenilla F, Pobo A, Vallés J, Ferri C, Martín-Loeches I, Díaz E, López D, López-Pueyo MJ, Gordo F, del Nogal F, Marqués A, Tormo S, Fuset MP, Pérez F, Bonastre J, Suberviola B, Navas E, León C. [Recommendations of the Infectious Diseases Work Group (GTEI) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) and the Infections in Critically Ill Patients Study Group (GEIPC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) for the diagnosis and treatment of influenza A/H1N1 in seriously ill adults admitted to the Intensive Care Unit]. Med Intensiva 2012; 36:103-37. [PMID: 22245450 DOI: 10.1016/j.medin.2011.11.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 11/20/2011] [Indexed: 02/08/2023]
Abstract
The diagnosis of influenza A/H1N1 is mainly clinical, particularly during peak or seasonal flu outbreaks. A diagnostic test should be performed in all patients with fever and flu symptoms that require hospitalization. The respiratory sample (nasal or pharyngeal exudate or deeper sample in intubated patients) should be obtained as soon as possible, with the immediate start of empirical antiviral treatment. Molecular methods based on nucleic acid amplification techniques (RT-PCR) are the gold standard for the diagnosis of influenza A/H1N1. Immunochromatographic methods have low sensitivity; a negative result therefore does not rule out active infection. Classical culture is slow and has low sensitivity. Direct immunofluorescence offers a sensitivity of 90%, but requires a sample of high quality. Indirect methods for detecting antibodies are only of epidemiological interest. Patients with A/H1N1 flu may have relative leukopenia and elevated serum levels of LDH, CPK and CRP, but none of these variables are independently associated to the prognosis. However, plasma LDH> 1500 IU/L, and the presence of thrombocytopenia <150 x 10(9)/L, could define a patient population at risk of suffering serious complications. Antiviral administration (oseltamivir) should start early (<48 h from the onset of symptoms), with a dose of 75 mg every 12h, and with a duration of at least 7 days or until clinical improvement is observed. Early antiviral administration is associated to improved survival in critically ill patients. New antiviral drugs, especially those formulated for intravenous administration, may be the best choice in future epidemics. Patients with a high suspicion of influenza A/H1N1 infection must continue with antiviral treatment, regardless of the negative results of initial tests, unless an alternative diagnosis can be established or clinical criteria suggest a low probability of influenza. In patients with influenza A/H1N1 pneumonia, empirical antibiotic therapy should be provided due to the possibility of bacterial coinfection. A beta-lactam plus a macrolide should be administered as soon as possible. The microbiological findings and clinical or laboratory test variables may decide withdrawal or not of antibiotic treatment. Pneumococcal vaccination is recommended as a preventive measure in the population at risk of suffering severe complications. Although the use of moderate- or low-dose corticosteroids has been proposed for the treatment of influenza A/H1N1 pneumonia, the existing scientific evidence is not sufficient to recommend the use of corticosteroids in these patients. The treatment of acute respiratory distress syndrome in patients with influenza A/H1N1 must be based on the use of a protective ventilatory strategy (tidal volume <10 ml / kg and plateau pressure <35 mmHg) and positive end-expiratory pressure set to high patient lung mechanics, combined with the use of prone ventilation, muscle relaxation and recruitment maneuvers. Noninvasive mechanical ventilation cannot be considered a technique of choice in patients with acute respiratory distress syndrome, though it may be useful in experienced centers and in cases of respiratory failure associated with chronic obstructive pulmonary disease exacerbation or heart failure. Extracorporeal membrane oxygenation is a rescue technique in refractory acute respiratory distress syndrome due to influenza A/H1N1 infection. The scientific evidence is weak, however, and extracorporeal membrane oxygenation is not the technique of choice. Extracorporeal membrane oxygenation will be advisable if all other options have failed to improve oxygenation. The centralization of extracorporeal membrane oxygenation in referral hospitals is recommended. Clinical findings show 50-60% survival rates in patients treated with this technique. Cardiovascular complications of influenza A/H1N1 are common. Such problems may appear due to the deterioration of pre-existing cardiomyopathy, myocarditis, ischemic heart disease and right ventricular dysfunction. Early diagnosis and adequate monitoring allow the start of effective treatment, and in severe cases help decide the use of circulatory support systems. Influenza vaccination is recommended for all patients at risk. This indication in turn could be extended to all subjects over 6 months of age, unless contraindicated. Children should receive two doses (one per month). Immunocompromised patients and the population at risk should receive one dose and another dose annually. The frequency of adverse effects of the vaccine against A/H1N1 flu is similar to that of seasonal flu. Chemoprophylaxis must always be considered a supplement to vaccination, and is indicated in people at high risk of complications, as well in healthcare personnel who have been exposed.
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Affiliation(s)
- A Rodríguez
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, IISPV - URV - CIBER Enfermedades Respiratorias, Tarragona, España.
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Abstract
Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are distinctly modern clinical entities. Recent epidemiologic research has taken advantage of large cohorts in efforts to better describe these highly lethal syndromes with a focus on differentiation of clinically meaningful subtypes and early prediction in an effort to improve treatment and prevention. This article identifies the most significant studies and systematic reviews of recent years, defining the incidence, mortality, risk and prognostic factors, and etiologic classes of ARDS/ALI.
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Affiliation(s)
- Ross Blank
- Division of Critical Care, Department of Anesthesiology, University of Michigan Health System, 1500 East Medical Center Drive, SPC 5861, Ann Arbor, MI 48109-5861, USA.
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Affiliation(s)
- Richard G Wunderink
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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Viviani L, Assael BM, Kerem E. Impact of the A (H1N1) pandemic influenza (season 2009-2010) on patients with cystic fibrosis. J Cyst Fibros 2011; 10:370-6. [PMID: 21752728 DOI: 10.1016/j.jcf.2011.06.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 05/29/2011] [Accepted: 06/15/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Influenza, like other respiratory viral infections, can cause acute deterioration of lung function in patients with cystic fibrosis (CF). Previous studies on a small number of patients reported that most people with CF infected with A (H1N1) influenza experienced a mild course of disease. AIM To characterise the impact of A (H1N1) infection on CF in a large number of patients from different centres and countries. METHODS CF centres accessing the web-site of the European Cystic Fibrosis Society (ECFS) were asked to report clinical data on patients with an ascertained diagnosis of influenza caused by the A (H1N1) virus. The study was web-based and data were collected through an electronic data sheet on the ECFS website. RESULTS Twenty-five centres from 10 countries caring for 4698 patients with CF reported data on 110 patients (2.3%), median age 13 years (range 1-39 years). The prevalence of infection in each centre ranged from 0% to 9.4%. Only 8.8% of the patients had been vaccinated. The main symptoms were fever and respiratory exacerbation requiring IV antibiotics in 53% of the patients; 48% of the patients were hospitalised for an average of 12.9 days (range 2-56) and 31% required oxygen treatment during the time of the infection. Most of the patients recovered and FEV(1) 1 month after the infection was similar to that before the infection. However, 6 patients were admitted to ICU, 5 with mechanical ventilation. Three patients with severe respiratory disease died. CONCLUSIONS A (H1N1) influenza infection caused transient but significant morbidity in most of the patients with CF. However, in a small number of patients with severe lung disease, A (H1N1) influenza was associated with respiratory deterioration, mechanical ventilation and even death.
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Affiliation(s)
- Laura Viviani
- Dipartimento di Medicina del Lavoro Clinica del Lavoro L. Devoto, Sezione di Statistica Medica e Biometria G.A.Maccacaro, Università degli Studi di Milano, Italy
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Gómez Grande ML. [Noninvasive ventilation in pneumonia due to N1H1 virus]. Med Intensiva 2011; 35:457-9. [PMID: 21722992 DOI: 10.1016/j.medin.2011.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
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First influenza season after the 2009 pandemic influenza: report of the first 300 ICU admissions in Spain. Med Intensiva 2011; 35:208-16. [DOI: 10.1016/j.medin.2011.03.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 03/09/2011] [Accepted: 03/10/2011] [Indexed: 11/19/2022]
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Scheible K, Zhang G, Baer J, Azadniv M, Lambert K, Pryhuber G, Treanor JJ, Topham DJ. CD8+ T cell immunity to 2009 pandemic and seasonal H1N1 influenza viruses. Vaccine 2011; 29:2159-68. [PMID: 21211588 PMCID: PMC3061835 DOI: 10.1016/j.vaccine.2010.12.073] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 12/08/2010] [Accepted: 12/16/2010] [Indexed: 12/17/2022]
Abstract
A novel strain of H1N1 influenza A virus (pH1N1) emerged in 2009, causing a worldwide pandemic. Several studies suggest that this virus is antigenically more closely related to human influenza viruses that circulated prior to 1957 than viruses of more recent seasonal influenza varieties. The extent to which individuals who are naïve to the 2009 pH1N1 virus carry cross-reactive CD8+ T cells is not known, but a certain degree of reactivity would be expected since there is substantial conservation among the internal proteins of the virus. In the present study, we examined the production of multiple cytokines in response to virus from CD8+ T cells in healthy adult subjects, between 18 and 50 years of age (born post 1957), who had no evidence of exposure to the 2009 pH1N1 virus, and had blood collected prior to the emergence of the pandemic in April of 2009. Human peripheral blood mononuclear cells (PBMCs) were stimulated in vitro with a panel of live viruses, and assayed by intracellular cytokine staining and flow cytometry. Although results were variable, most subjects exhibited cytokine positive CD8+ T cells in response to pH1N1. Cytokine producing cells were predominantly single positive (IL2, IFNγ, or TNFα); triple-cytokine producing cells were relatively rare. This result suggests that although many adults carry cross-reactive T cells against the emergent pandemic virus, these cells are in a functionally limited state, possibly because these subjects have not had recent exposure to either seasonal or pandemic influenza strains.
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Affiliation(s)
- Kristin Scheible
- New York Influenza Center of Excellence, David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology; University of Rochester Medical Center, Rochester, NY 14642, USA
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Gang Zhang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Jane Baer
- New York Influenza Center of Excellence, David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology; University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Mitra Azadniv
- New York Influenza Center of Excellence, David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology; University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Kris Lambert
- New York Influenza Center of Excellence, David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology; University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Gloria Pryhuber
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - John J. Treanor
- New York Influenza Center of Excellence, David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology; University of Rochester Medical Center, Rochester, NY 14642, USA
- Division of Infectious Diseases, Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - David J. Topham
- New York Influenza Center of Excellence, David H. Smith Center for Vaccine Biology and Immunology, Department of Microbiology and Immunology; University of Rochester Medical Center, Rochester, NY 14642, USA
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